biostudies-literatureUnknown8(3)Rhee C<h4>Importance</h4>The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) is supported by observational studies that report SEP-1 compliance is associated with lower mortality. Most studies, however, adjusted for limited confounders and provided little insight into why bundle-compliant care was not provided.<h4>Objectives</h4>To identify the clinical factors that complicate the diagnosis and management of sepsis and assess their association with SEP-1 compliance and mortality.<h4>Design, setting, and participants</h4>This retrospective cohort study was conducted among 590 adults with sepsis in the emergency department of 4 academic hospitals from January 1, 2019, to December 31, 2022. Patients' medical records were reviewed between September 2JAMA network opene251100https://www.ebi.ac.uk/biostudies/studies/S-EPMC11923707biostudies-literatureComplex Sepsis Presentations, SEP-1 Compliance, and Outcomes.PMC11923707Filbin MRRoach DJFaine BATrain SEMohr NMPark STKlompas MPlechot KZepeski ARhee CDelloStritto LShappell CNYu TPorter EfalseComplex Sepsis Presentations, SEP-1 Compliance, and Outcomes.<h4>Importance</h4>The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) is supported by observational studies that report SEP-1 compliance is associated with lower mortality. Most studies, however, adjusted for limited confounders and provided little insight into why bundle-compliant care was not provided.<h4>Objectives</h4>To identify the clinical factors that complicate the diagnosis and management of sepsis and assess their association with SEP-1 compliance and mortality.<h4>Design, setting, and participants</h4>This retrospective cohort study was conducted among 590 adults with sepsis in the emergency department of 4 academic hospitals from January 1, 2019, to December 31, 2022. Patients' medical records were reviewed between September 22025-01-01T00:00:00Z2025 Mar2025-04-03T23:26:41.675Z2025-04-03T23:26:41.675ZS-EPMC119237074010584110.1001/jamanetworkopen.2025.1100